Higher anti-depressant dose and major adverse outcomes in moderate chronic kidney disease: a retrospective population-based study

被引：7

作者：

Dev, Varun ^{[1
]}

Dixon, Stephanie N. ^{[1
,2
,3
,4
]}

Fleet, Jamie L. ^{[2
]}

Gandhi, Sonja ^{[1
,2
,3
]}

Gomes, Tara ^{[4
,5
,6
]}

Harel, Ziv ^{[7
]}

Jain, Arsh K. ^{[1
,2
,3
]}

Shariff, Salimah Z. ^{[1
,4
]}

Tawadrous, Davy ^{[1
,2
]}

Weir, Matthew A. ^{[1
,2
,3
]}

Garg, Amit X. ^{[1
,2
,3
,4
,8
]}

机构：

[1] Western Univ, Schulich Sch Med, London, ON, Canada

[2] Western Univ, Div Nephrol, London, ON, Canada

[3] Western Univ, Dept Epidemiol & Biostat, London, ON, Canada

[4] Inst Clin Evaluat Sci, Toronto, ON, Canada

[5] Univ Toronto, Leslie Dan Fac Pharm, Toronto, ON, Canada

[6] Li Ka Shing Knowledge Inst, Keenan Res Ctr, Toronto, ON, Canada

[7] Univ Toronto, Div Nephrol, Toronto, ON, Canada

[8] London Hlth Sci Ctr, London Kidney Clin Res Unit, London, ON N6A 4G5, Canada

来源：

BMC NEPHROLOGY | 2014年 / 15卷

关键词：

Anti-depressant; Delirium; Aged; Chronic renal insufficiency; Cohort studies; Risk; ANTIDEPRESSANTS; DELIRIUM; MEDICATION; PAROXETINE; ANXIETY; RISK;

D O I：

10.1186/1471-2369-15-79

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Many older patients have chronic kidney disease (CKD), and a lower dose of anti-depressants paroxetine, mirtazapine and venlafaxine is recommended in patients with CKD to prevent drug accumulation from reduced elimination. Using information available in large population-based healthcare administrative databases, we conducted this study to determine if ignoring the recommendation and prescribing a higher versus lower dose of anti-depressants associates with a higher risk of adverse events. Methods: We conducted a population-based cohort study to describe the 30-day risk of delirium in older adults who initiated a higher vs. lower dose of these three anti-depressants in routine care. We defined delirium using the best proxy available in our data sources - hospitalization with an urgent head computed tomography (CT) scan. We determined if CKD status modified the association between anti-depressant dose and outcome, and examined the secondary outcome of 30 day all-cause mortality. We used multivariable logistic regression analyses to estimate adjusted odds ratios (relative risk (RR)) and 95% confidence intervals. Results: We identified adults (mean age 75) in Ontario who started a new study anti-depressant at a higher dose (n = 36,651; 31%) or lower dose (n = 81,160; 69%). Initiating a higher vs. lower dose was not associated with an increased risk of hospitalization with head CT (1.09% vs. 1.27% (adjusted RR 0.90; 95% CI, 0.80 to 1.02), but was associated with a lower risk of all-cause mortality (0.76% vs. 0.97% RR 0.82; 95% CI, 0.71 to 0.95). Neither of these relative risks were modified by the presence of CKD (p = 0.16, 0.68, respectively). Conclusions: We did not observe an increase in two adverse outcomes when study anti-depressants were initiated at a higher dose in elderly patients with moderate CKD. Contrary to our hypothesis, the 30-day risk of mortality was lower when a higher versus lower dose of anti-depressant was initiated in these patients, a finding which requires corroboration and further study.

引用

页数：9

共 37 条

[1] Venlafaxine-induced delirium [J].